Team-based Care Research Articles

Obesity and diabetes in heart disease in women

Heart disease remains a major health threat in women. Cardiometabolic risk factors such as obesity and diabetes differentially and adversely impact heart disease risk. Although obstructive coronary artery disease is an important cause of ischemic heart disease in women and is prognostic, women are more likely to have angina and myocardial ischemia without obstructive atherosclerosis, which has been attributed to coronary microvascular dysfunction (CMD). Heart failure with preserved ejection fraction (HFpEF) is another condition that predominates in women. CMD and HFpEF are both associated with cardiometabolic risk factors that are prevalent in women. Women are also more likely to have additional risk-enhancing conditions such as autoimmune dysfunction, chronic inflammation, and sex-specific hormonal factors that adversely influence risk. In this review, we focus on cardiometabolic risk factors of obesity and diabetes in heart disease in women, including ischemic heart disease from CMD, HFpEF, and arrythmias. Team-based care to focus on cardiometabolic risk reduction is needed to alter adverse heart disease outcomes in women. Identification, education, treatment, and active surveillance of these dysmetabolic risk factors are imperative in the primary and secondary prevention of heart disease in women.

Testing an Innovative Approach to Improve Hypertension Management at a Federally Qualified Health Center.

Despite the availability of effective treatments, hypertension control rates remain inadequate in the United States and locally in Los Angeles County. To address this health condition, QueensCare Health Centers developed and launched a team-based hypertension management program that was led by clinical pharmacists and designed to mitigate treatment barriers encountered at the system, provider, and patient levels. System- and provider-focused strategies included incorporating self-monitored blood pressure values into the electronic health record and retraining clinicians to regularly review these values; adding a community health worker to the disease management team; and utilizing clinical pharmacists to assess and titrate medications. Patient-focused strategies included tailoring education materials to reduce literacy and linguistic barriers; providing tailored one-on-one education and support; and providing blood pressure cuffs and pedometers. This multilevel intervention serves as a practical example of how team-based care can be optimized at a Federally Qualified Health Center.

Physiotherapist and Patient Experiences of Team-Based Interprofessional Collaboration during the COVID-19 Pandemic in Canada

Purpose: To examine the perspectives of physiotherapists and physiotherapy patients regarding team-based interprofessional collaboration during the COVID-19 pandemic in Canada. Methods: This mixed methods study combined online surveys (physiotherapists, patients) and qualitative semi-structured interviews (patients). Descriptive statistics and thematic analysis summarized the quantitative and qualitative data before final data integration. Results: Physiotherapists (n = 334) and patients (n = 784) participated in the surveys, while 19 patients were interviewed. Less than half (48%) of physiotherapists reported delivering care as part of multidisciplinary teams and 38% of these individuals reported that the pandemic decreased their ability to deliver team-based, interprofessional care. Physiotherapists found that team-based care was negatively impacted by communication challenges, poor care coordination, and patients lacking access to other health professionals. While over one-third (38%) of patients reported poor care coordination between health professionals, qualitatively many patients reported that these challenges were similar pre-pandemic. They also experienced increased communication challenges and emphasized poor access to general practitioners and specialists. Both groups saw future opportunities for increased use of virtual care to improve team-based health care delivery. Conclusion: Physiotherapists and patients had varied experiences with aspects of team-based care during the pandemic that included challenges with communication, care coordination, and ability to access health professionals. Improved training and implementation of virtual care may enhance interprofessional collaboration and improve patient care in the future.

Review of Connections in the clinic: Relational narratives from team-based primary care.

Reviews the book, Connections in the Clinic: Relational Narratives from Team-Based Primary Care edited by Randall Reitz, Laura E. Sudano, and Mark P. Knudson (2021). This book is an edited collection of poems and stories reflecting the personal nature of the mission, vision, and practice of integrated primary care. This collection reflects the biopsychosocial model, which has been growing steadily in research and practice over the last few decades. These stories from the frontlines illustrate the increased awareness of the strong mind-body-interpersonal and team connections that are a critical part of a successful primary care system. This book is intended to be inspirational for anyone working in a primary care clinic. The editors describe the central purpose of the book is to find meaning in the relationships that are created in team-based primary care. This is a book where these stories are collected to expand our recognition and appreciation of the full diversity of patterns in our personal and work lives. The collection of stories is intended to inspire readers to actively practice their own reflections and learnings and encourages sharing them with others. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Rapid Nurse Training to Meet Surge Capacity: An Integrative Review.

The COVID-19 pandemic resulted in unprecedented health care challenges and transformation of nursing practice. A significant challenge faced by health care systems was the rapid identification and training of nurses in various specialties, including critical care, to care for a large influx of critically ill patients. To identify common themes and modalities that support best practices for the rapid training of registered nurses in team-based critical care nursing. With the Whittemore and Knafl integrative review methodology as a framework, a literature review was conducted using a priori search terms. The integrative review included 11 articles and revealed 3 common themes: communication challenges, team dynamics, and the methodological approach to implementing training. This integrative review highlighted 3 main implications for future practice and policy in the event of another pandemic. Clear and frequent communication, multidisciplinary huddles, and open communication are paramount for mitigating role confusion and enhancing team dynamics. A multimodal approach to training appears to be feasible and effective for rapidly training support registered nurses to care for critically ill patients. However, the optimal training duration remains unidentified. Rapidly training registered nurses to care for critically ill patients in a team-based dynamic is a safe and effective course of action to mitigate staff shortages if another pandemic occurs.

Precision medicine preceptorship in breast and lung cancer for Latin American oncologists.

9040 Background: Cancer is the second leading cause of death in Latin America. Integrating genomic discoveries into patient care could improve morbidity and mortality; however economic barriers to capacity development and access to therapeutics remain. In response to an RFP for a preceptorship for oncologists from Latin America, Emory’s Winship Cancer Institute (WCI) developed a 2-week immersion involving didactics, clinical exposures, and research meetings to increase knowledge and competence of breast and lung cancer genomics. Methods: Interviews with Latin American medical oncologists, Latin America Lung Cancer Association (LALCA) leadership, and literature review were conducted to understand areas of unmet need in oncology training. A gap in knowledge and practice of genomic management of breast and lung cancer was identified and informed development of didactic and clinical exposures. The WCI website, International Association for the Study of Lung Cancer (IASLC) and LALCA publicized the program. Medical oncologists within 6 years of final oncology training applied. Participants completed a baseline needs assessment, pre-program survey to assess goals and confidence in skills, and post-program interview to evaluate the program and reassess confidence in skills. Instruments were developed with WCI’s Intervention, Development, Dissemination and Implementation Shared Resource. WCI faculty were interviewed for feedback. Results: WCI hosted 12 Latin American oncologists over 3 two-week preceptorships between 2020-23, coinciding with local scientific meetings. All participants reported the program was a valuable use of time, valuable for career development and rated the program as excellent/very good. 92% reported the program met their goals and felt engaged all/most of the time. 75% rated attendance at breast and lung cancer clinics, didactics, research meetings, tumor boards as very/extremely valuable. Two-thirds intended to make changes (apply knowledge, improve communication, work with other providers like nurses, aid students in research, improve flow of activity when seeing patients, incorporate clinical research into daily practice, and add immunotherapy) in their practice at home institutions. Phase 1 and surgical oncology clinics were deemed least helpful. Themes emerged from faculty interviews: be strategic about the number of learners in clinic, characterize learner preferences and prior training/experience, articulate the preceptorship’s long-term goals, and include time to team-build. Conclusions: Participants gained exposure to the latest molecular diagnostics and systemic treatments, appreciation for optimal team-based cancer care, and how clinical research drives development of novel biomarkers and therapeutics. Future goals include expanding program access to oncologists from other low- and middle-income countries and promoting post-program collaborations.

Perceptions of Responsibilities by Primary Care Staff in a Patient-Centered Medical Home.

To examine the extent to which Veterans Health Administration (VHA) Patient-Aligned Care Team (PACT) members have a shared understanding/ agreement upon and enact responsibilities within the team. The PACT model focuses on team-based care management. However, lack of a shared understanding of team-based care management roles and responsibilities makes system-wide implementation a challenge. Quantitative and qualitative analysis of national survey data collected in 2022 from primary care personnel working in a VHA-affiliated primary care facility. Significant discrepancies exist in responses about what core team members say they do and what others perceive they should be doing, indicating either a lack of agreement, knowledge, or training about what core team members should do. Successful implementation of a team-based model requires adequate support and training for teamwork including shared mental models to work according to their clinical competency. Clear guidance and communication of expectations are critical for role clarity.

Post-Intensive Care Syndrome in Neurocritical Care Patients.

Post-intensive care syndrome (PICS) refers to unintended consequences of critical care that manifest as new or worsening impairments in physical functioning, cognitive ability, or mental health. As intensive care unit (ICU) survival continues to improve, PICS is becoming increasingly recognized as a public health problem. Studies that focus on PICS have typically excluded patients with acute brain injuries and chronic neurodegenerative problems. However, patients who require neurocritical care undoubtedly suffer from impairments that overlap substantially with those encompassed by PICS. A major challenge is to distinguish between impairments related to brain injury and those that occur as a consequence of critical care. The general principles for the prevention and management of PICS and multidomain impairments in patients with moderate and severe neurological injuries are similar including the ICU liberation bundle, multidisciplinary team-based care throughout the continuum of care, and increasing awareness regarding the challenges of critical care survivorship among patients, families, and multidisciplinary team members. An extension of this concept, PICS-Family (PICS-F) refers to the mental health consequences of the intensive care experience for families and loved ones of ICU survivors. A dyadic approach to ICU survivorship with an emphasis on recognizing families and caregivers that may be at risk of developing PICS-F after neurocritical care illness can help improve outcomes for ICU survivors. In this review, we will summarize our current understanding of PICS and PICS-F, emerging literature on PICS in severe acute brain injury, strategies for preventing and treating PICS, and share our recommendations for future directions.

Establishing consensus on nutrition competencies for medicine: a Delphi study

BackgroundSignificant research, regulatory bodies and even governmental resolutions have identified meaningful nutrition education for medical and other healthcare professionals as a priority. Doctors are well placed to provide nutrition care,...

Position of the Infectious Diseases Society of America and the HIV Medicine Association on Team-based Infectious Diseases Care and the Roles of Advanced Practice Providers and Clinical Pharmacists.

Strengthening and expanding interprofessional team-based care is an important component of the Infectious Diseases Society of America's Workforce Development Strategy to expand and promote equitable access to expert infectious diseases (ID) care. This statement defines the roles of care team members and highlights the need for ID curricula and training programs for advanced practice providers to support implementation of ID team-based care.

Team-Based HIV Care Is the Best Care.

Team-Based HIV Care Is the Best Care.

The Community Primary Care Champions Fellowship: a mixed methods evaluation of an interprofessional fellowship for physician assistants and physicians

BackgroundPrimary care in the US faces challenges with clinician recruitment, retention, and burnout, with further workforce shortages predicted in the next decade. Team-based care can be protective against clinician burnout, and opportunities for interprofessional education (IPE) on professional development and leadership could encourage primary care transformation. Despite an increasingly important role in the primary care workforce, IPE initiatives training physician assistants (PAs) alongside physicians are rare. We describe the design, curriculum, and outcomes from an interprofessional primary care transformation fellowship for community-based primary care physicians and PAs.MethodsThe Community Primary Care Champions (CPCC) Fellowship was a one-year, part-time fellowship which trained nine PAs, fourteen physicians, and a behavioralist with at least two years of post-graduate clinical experience in six content pillars: quality improvement (QI), wellness and burnout, mental health, social determinants of health, medical education, and substance use disorders. The fellowship included a recurring schedule of monthly activities in self-study, lectures, mentoring, and community expert evening discussions. Evaluation of the fellowship included pre, post, and one-year follow-up self-assessments of knowledge, attitudes, and confidence in the six content areas, pre- and post- wellness surveys, lecture and discussion evaluations, and midpoint and exit focus groups.ResultsFellows showed significant improvement in 24 of 28 self-assessment items across all content areas post-fellowship, and in 16 of 18 items one-year post-fellowship. They demonstrated reductions in emotional exhaustion and depersonalization post-fellowship and increased confidence in working in interprofessional teams post-fellowship which persisted on one-year follow-up assessments. All fellows completed QI projects and four presented their work at national conferences. Focus group data showed that fellows experienced collaborative, meaningful professional development that was relevant to their clinical work. They appreciated the flexible format and inclusion of interprofessional community experts in evening discussions.ConclusionsThe CPCC fellowship fostered an interprofessional community of practice that provided an effective IPE experience for physicians and PAs. The learning activities, and particularly the community expert discussions, allowed for a flexible, relevant experience, resulting in personal and professional growth along with increased confidence working within interprofessional teams.

Design and rationale of the cardiometabolic health program linked with community health workers and mobile health telemonitoring to reduce health disparities (LINKED-HEARTS) program

Hypertension and diabetes are major risk factors for cardiovascular diseases, stroke, and chronic kidney disease (CKD). Disparities in hypertension control persist among Black and Hispanic adults and persons living in poverty in the United States. The "LINKED-HEARTS Program" (a Cardiometabolic Health Program LINKED with Community Health WorkErs and Mobile HeAlth TelemonitoRing To reduce Health DisparitieS"), is a multi-level intervention that includes home blood pressure (BP) monitoring (HBPM), blood glucose telemonitoring, and team-based care. This study aims to examine the effect of the LINKED-HEARTS Program intervention in improving BP control compared to enhanced usual care (EUC) and to evaluate the reach, adoption, sustainability, and cost-effectiveness of the program. Using a hybrid type I effectiveness-implementation design, 428 adults with uncontrolled hypertension (systolic BP ≥ 140 mm Hg) and diabetes or CKD will be recruited from 18 primary care practices, including community health centers, in Maryland. Using a cluster-randomized trial design, practices are randomly assigned to the LINKED-HEARTS intervention arm or EUC arm. Participants in the LINKED-HEARTS intervention arm receive training on HBPM, BP and glucose telemonitoring, and community health worker and pharmacist telehealth visits on lifestyle modification and medication management over 12 months. The primary outcome is the proportion of participants with controlled BP (<140/90 mm Hg) at 12 months. The study tests a multi-level intervention to control multiple chronic diseases. Findings from the study may be leveraged to reduce disparities in the management and control of chronic diseases and make primary care more responsive to the needs of underserved populations. ClinicalTrials.gov. Identifier: NCT05321368.

Enhancing Early Identification of Speech-Language-Hearing Delays Through Interprofessional Peer Teaching in a Communication Sciences and Disorders Graduate Training Program.

In the current health care landscape, a paradigm shift toward team-based care is underway. Integrating interprofessional education experiences into graduate communication sciences and disorders (CSD) programs is essential to cultivate collaborative skills and prepare future professionals for the interprofessional demands of the field. Within this context, peer teaching has emerged as a noteworthy strategy to promote learning. This study aims to contribute to this evolving field by reporting the impact of an interprofessional (speech-language pathology and audiology) peer teaching educational intervention on physician assistant (PA) students' knowledge of speech-language-hearing developmental milestones and developmental screening. A quantitative, descriptive methodology with a pretest, posttest interventional design was utilized to assess the impact of a CSD peer-led educational intervention on the knowledge of 35 PA students. The perceived satisfaction of the PA students with the peer-led educational experience was also evaluated. Data analysis revealed a significant increase on knowledge posttest scores compared to pretest scores. PA students also reported an overall positive peer learning experience. The collaboration between speech-language pathology, audiology, and PA students through peer teaching holds significant importance in the context of pediatric primary care, and for CSD graduate trainings programs interested in improving educational experiences that tailor to interprofessional learning and practice.

Digitally mediated relationships: How social representation in technology influences the therapeutic relationship in primary care

Relationships, built on trust, knowledge, regard, and loyalty, have been demonstrated to be fundamental to health care delivery. Strong relationships between patients and providers have been linked to more compassionate care delivery, and better patient experience and outcomes, and may be particularly important in primary care. The rapid adoption of digital technologies since the onset of COVID-19 has led health care systems to seriously consider a “digital-first” primary care delivery model. Questions remain regarding what impact this transformation will have on the therapeutic relationship. Using a rapid ethnographic approach this study explores how patient and provider understandings of therapeutic relationships and digital health technologies may influence relationship-building or maintenance between patients with complex care needs and their care providers. Three team-based primary care sites in Toronto, Ontario, Canada were included in the study. Across the three sites 9 patients with chronic health conditions, 1 caregiver, and 10 healthcare providers (including family physicians, family medicine residents, social workers, and nurse practitioners) participated. Interviews were conducted with all participants and 8 observations of virtual clinical encounters (phone and video visits) were conducted. Using social representation theory as a lens, analysis revealed that participants' constructions of therapeutic relationships and digital technologies were informed by their identities, experiences, and expectations. For participants to see technologies as enabling to the therapeutic relationship, there needed to be alignment between how participants viewed the role of technology in care and in their lives, and how they recognized (or constructed) a good therapeutic relationship. This exploratory work suggests the need to think about how both patients' and providers’ views of technology may determine whether digital technologies can be leveraged to meet patient needs while maintaining, or building, strong therapeutic relationships.

Drivers of hospital nurse practitioner turnover: A national sample survey analysis

BackgroundHospital nurse practitioner (NP) turnover is costly and complex. PurposeProvide a pre-COVID-19 pandemic baseline of hospital NP turnover. MethodsA secondary analysis of NSSRN18 data on 6,558 (67,863 weighted) NPs employed in hospitals on 12/31/2017. We describe rates of turnover, intention to leave, and reasons for leaving or staying. Using multivariate logistic regression, we examine the association between individual and organizational characteristics and turnover. Survey weights and jackknife standard errors were applied to analyses. DiscussionApproximately 10% of NPs left their job the following year, and 53% of NPs that remained considered leaving at some point. The top reasons cited for leaving or staying were largely organizational factors. Regression analysis revealed not practicing to one’s fullest scope, lower income, lack team-based care, and non-white race were associated with an increased likelihood to leave. ConclusionWe find several modifiable factors associated with hospital NP turnover that can be used to tailor recruitment and retention strategies.

Preventable trauma deaths in the Western Cape of South Africa: A consensus-based panel review.

Injury causes 4.4 million deaths worldwide annually. 90% of all injury-related deaths occur in low-and-middle income countries. Findings from expert-led trauma death reviews can inform strategies to reduce trauma deaths. A cohort of trauma decedents was identified from an on-going study in the Western Cape Province of South Africa. For each case, demographics, injury characteristics, time and location of death and postmortem findings were collected. An expert multidisciplinary panel of reviewed each case, determined preventability and made recommendations for improvement. Analysis of preventable and non-preventable cases was performed using Chi-square, Fisher's exact, and Wilcoxon signed rank tests. A rapid qualitative analysis of recommendations was conducted and descriptively summarized. 138 deaths (48 deceased-on-scene and 90 pre- or in-hospital deaths) were presented to 23 panelists. Overall, 46 (33%) of deaths reviewed were considered preventable or potentially preventable. Of all pre- and in-hospital deaths, late deaths (>24 hours) were more frequently preventable (22, 56%) and due to multi-organ failure and sepsis, compared to early deaths (≤24 hours) with 32 (63%) that were non-preventable and due to central nervous system injury and haemorrhage. 45% of pre and in-hospital deaths were preventable or potentially preventable. The expert panel recommended strengthening community based primary prevention strategies for reducing interpersonal violence alongside health system improvements to facilitate high quality care. For the health system the panel's key recommendations included improving team-based care, adherence to trauma protocols, timely access to radiology, trauma specialists, operative and critical care.

An Update on Interprofessional Education and Practice in North Carolina: The State of the State.

Team-based care, the optimal result of interprofessional education and often referred to as interprofessional practice, is a critical ingredient in the success of efforts to address health and workforce needs. Articles in this issue provide an update on what has occurred across North Carolina related to team-based care since this journal last covered it in 2018, highlighting innovations and infrastructure that address health equity, population-based care, reducing costs, and increasing quality.

Behavioral Health Access and Workforce Competence for Integrated Care: Highlighting Interprofessional Initiatives from Two North Carolina Social Work Programs.

Effective team-based care is necessary for implementation of the integrated care models recommended to improve behavioral health access. Many models rely on social work-ers who are trained to deliver behavioral health care as an interprofessional team member. In this article, we highlight two social work programs utilizing interprofessional educa-tion to enhance team-based care competence.

New IPEC Competencies, the State of the Science, and a Focus on Equity.

From the value of team-based patient care to the focus on the learner, the 2023 Interprofessional Education Collaborative Core Competencies include a more succinct approach to collaborative care. We review the changes and note their potential impacts on collaborative practice.